HomeMy Public PortalAbout10715 ARROWOOD ST_Sewer__ YDEPAIVfMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I
ADDRESS
FOR APPLICANT. TO FILL IN LOCALITY BUILDING
ADDRESS NEAREST
10715 ArroWood St o CROSS ST. e ,y ,
LOCALITY P1 Monte DISTRICT NO. �SSEERIAL N0. PERMIT NO. C
CNEAREST 6 -10-4 ROSS ST. Ely Monte Av@ o A "� ��� ���� S
RECEI EE�B Ready for inspection /DATE ISSUEEDD�
OWNER PnL. McNuttMAIL
JJ ( 7 ®'/
ADDRESS 272 San Gabriel Bledo USE OCCUPANCY BK MAP PG
CITY San GabrielTEL•NO• At 94364
CONTRACTOR L,, D, & MA ConStrUation Coy, CO.IMP.NO.
ADDRESS 408 Winthrop Dro ,OB NO.
CITY Alhambra TELAO. AT 48315
TRUNK PEAM.IT N0.
STATE
REGISTRATION NO. 113613 C 42 COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. 33 STATE ENCF,OACHMENT
PERMIT NO. \
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE CF LOT NO.OF NOW ON LOTS , 'CH,A`RGES'
USE OF ,
BUILDINGS I RgQ„ CONNECTION CHARGEFEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT EE i
PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE J)BYE
HOUSE SEWER CONNECTING TO 'v
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPT!qXRECITRDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO
DATE . I BY
SEWER OR DISPOSAL SYSTEM 1.00 yrs/.
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOLDRYWELL
SPECIAL CONDITIONS ONLY 2.00 ® ANHOLE REFERENCE
Q UPPER
TYPE OF CONNECTION LENGTH FROM
OWNERS
PERMIT $ I 00 ' '`� _CURB P.L.A M I TO�P2L
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--------------------DAY OF----------------------------------------19---_--- NEW HOUSE SEWER 15z"z
OWNER OR ( CONNECT ADDI.TIONAL
OWNERS AGENT........................................ BUILDING OR WORK
ADDRESS-----------------------_------------.----.--------_. SEPTIC TANK,SEEP.PIT(S)
- -- - - ' AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE g _
SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE- '---- 2 .yZ!-iL�-..� .
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